Is radiation for initial treatment different than adjuvant radiation?

[cfrees1]

On some FB forums, it has been suggested that if the chances are that you will need to get radiation after surgery anyway, why not just skip the surgery step and go right to radiation? I'm wondering if the treatments are the same? If this was true, why wouldn't everyone skip right to radiation? What would the advantage of surgery be?

[Tall_Allen]

In fact, the side effects of salvage radiation are worse than for primary radiation - you get the worst of both worlds.

As for the oncological results... For favorable risk PC surgery and radiation have equal recurrence rates. For unfavorable risk PC, radiation beats surgery because you can use combination radiation therapies and you are treating an area outside of the prostate that surgery cannot reach.

Most urologists seem to be ignorant about the various kinds of salvage therapies available if radiation fails - there are several good ones that do not include salvage surgery.

There are two advantages that surgery has over radiation:

(1) You get a pathology report telling you exactly what was in your prostate

(2) If successful, PSA will drop to undetectable levels immediately. There's no guarantee that it will stay undetectable, of course. But after radiation, PSA can take 4-5 years to achieve nadir and will probably never be completely undetectable because you have a live prostate.

Here are some good questions to ask yourself in deciding between them:

pcnrv.blogspot.com/2017/12/...

[JoelT]

You are confusing the role of primary radiation, primary surgery and adjuvant radiation.

The two most popular types of primary treatments available are radiation (which can include seeds, external beam, etc.) or surgery (open, lap or robotic). The stats on the outcomes from both these alternatives are surprisingly similar, about one third of men using either of these options will have a recurrence and require additional therapy. Additional therapy can include adjuvant radiation for men who have failed surgery, surgery for men who failed radiation (this is a messy and complex surgery), or some type of hormone therapy for men who have failed either radiation or surgery or both.

All of these treatment come with side effects, so over treatment as you have suggested might not provide any additional benefit, but will definitely have a major, negative impact on your quality of life.

Joel

[cfrees1 in reply to JoelT]

My urologist at the time of diagnosis suggested that there "appeared to be" some positive value in debulking the surgery first. So I guess the possibility that we may gain more time would be a reason to try surgery first. I'm not questioning my decision, just want to be sure that I'm replying accurately to people who say "why do surgery when 30% of the surgery people have to have follow-up radiation anyway?"

[JoelT in reply to cfrees1]

And 30% of people who do radiation also move on to another therapy. I am not suggesting that you you do surgery, there are individual and personal reasons that for one of us one or the other is the preferred primary treatment. There is not, in most situations, a right or wrong best treatment, just what w as individuals go on to decide to do.

[cfrees1 in reply to JoelT]

Oh, sorry, I'm well past a decision for myself. I had surgery, and I had adjuvant radiation, of course Lupron and then Bicalutamide which is now failing. So this question isn't for me and my decision process. It's just to correctly answer why surgery does make sense even in the event that there is a good chance that radiation will be needed anyway.

[billfenley2 in reply to cfrees1]

Sorry to hear about the Bicalutamide failing, friend.

[Dash54]

I was told there was a good chance I would need radiation after surgery. I did surgery first because once you have radiation surgery is harder and only a couple place will take out a radiated prostate if the scar tissue becomes an issue. Plus, I didn't like the idea of the dead prostate sitting in my body to cause possible problems later. I think it depends how old you are. I was 59. If I had been 69 or 79 I might have felt different about my options.

[Balsam01]

I am 72 and had rp. I did not want my gleason 9 tumor remaining in my body. I am now dealing with the after effects which was a PSA of 2.71 after surgery. I will do radiation but my goal is to string this out!

[cfrees1]

My initial question remains. Is the radiation that we get as adjuvant or salvage the same type, dosage etc. as the radiation patients get for initial treatment? Or is the answer to this question not as clear as I am assuming? Is all radiation the same?

[Break60 in reply to cfrees1]

IBRT is the same machine and process but dosage and radiation field may differ after RP because you now know where the PCa was and could be if it penetrated the capsule. Plus you can't have a brachy boost to IMRT once the prostate is gone.